Billing Specialist And Certified Coder

Job Overview:

A Medical Coder, or Certified Professional Coder, is responsible for reviewing a patient's medical records after a visit and translating the information into codes that insurers use to process claims. Their duties include confirming treatments with medical staff, identifying missing information and submitting forms to insurers for reimbursement.

Job Duties:

· Complying with medical coding guidelines and policies

· Collecting information from different sources to prepare monthly reports

· Interpreting a patient’s medical chart and assigning the appropriate diagnostic and procedural codes

· Verifying signatures and data

· Assigns CPT, HCPCS, ICD-10-, and DRG Codes

· Reviews the claims to make sure they are correct prior to submitting for reimbursement

· Corrects and resubmits denied claims

· Assigns codes to diagnoses and procedures, using ICD (International Classification of Diseases), CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System)

· Ensure codes are accurate and sequenced correctly in accordance with the government and insurance regulations.

· Follow up with the provider on any documentation that is insufficient or unclear

· Communicate with other clinical staff regarding documentation

· Search for information in cases where the coding is complex or unusual

· Receive and review patient charts and documents for accuracy

· Review the previous day’s batch of patient notes for evaluation and coding

· Ensure that all codes are current and active and in compliance with medical coding policies and guidelines

· Answers questions, advises, and trains providers and staff on medical coding

· Performs patient chart audits and provides coding feedback and education to administration team as needed

· Address and solve client questions and issues

· Preparing and submitting billing data and medical claims to insurance companies

· Examine patient bills for accuracy and request any missing information

· Unpaid claims follow up to ensure timely filing

· Identifying and billing secondary or tertiary insurances

· Daily review and correction of Commercial, Medicare and Medicaid insurances

· Print all required paper claims for Medicaid (secondaries)

· Maintain knowledge regarding coding and diagnostic procedures

· Enter Commercial, Medicare and Medicaid EFTs daily

· Communicate with patients and outside insurance companies/agencies to ensure proper processing of claims as needed

· Enters accurate data, verifying and updating insurance, and claims information, handles carrier correspondence, manages EOB’s, and keys payments received into system

· Investigates rejected claims to see why denials were issued and correct the claims for resubmission

· Follows HIPAA guidelines when accessing and sharing patient information

· All other Duties as Assigned by your immediate supervisor or administration

Job Qualifications:

· Associate degree in medical Coding with successful completion of a certificate program (AAPC)

· Strong knowledge of anatomy, physiology, and medical terminology

· Proficiency in computer skills including typing speed and accuracy

· Commitment to a high level of customer service

· Superior mathematical skills

· Familiarity with ICD codes and procedures

· Solid oral and written communication skills

· Working knowledge of medical jargon and anatomy

· Able to work independently or as an active member of a team

· Ability to multitask, prioritize and manage time efficiently

· Exceptional organizational skills

· Ability to maintain a high level of integrity and confidentiality of medical information

· Strict attention to details

· Knowledge of data entry and transcription

Continuing Education Materials:

· SGMC will reimburse and/or pay for, upon approval from Admin, any continuing education material necessary for the duties of the position and to meet educational compliance. This includes, but not limited to books, literature, extended training courses, etc.

Physical Requirements:

· Requires sitting and standing associated with a normal office environment.

· Performs highly complex and varied tasks requiring independent knowledge and its

application to a variety of situations, as well as exercising independent judgement.

• Requires the use of office equipment such as copiers, scanners, computers, telephones,

and fax machines.

• May view computer screens for long periods of time.

• Must be able to prioritize activities when faced with competing demands.

· Occasionally lift/carry up to 50lbs

· Occasionally push/pull up to 40lbs